Saturday, 21 May 2016

Most Common Disease of50plus: The Clinical trials and Studies of Musculo-Skeletal disorders(MSDs)- Gout - Treatment In TCM formula Ermiao wan

Kyle J. Norton (Scholar and Master of Nutrients, all right reserved)Health article writer and researcher; Over 10.000 articles and research papers have been written and published on line, including world wide health, ezine articles, article base, healthblogs, selfgrowth, best before it's news, the karate GB daily, etc.,.
Named TOP 50 MEDICAL ESSAYS FOR ARTISTS & AUTHORS TO READ by Disilgold.com Named 50 of the best health Tweeters Canada - Huffington Post
Nominated for shorty award over last 4 years
Some articles have been used as references in medical research, such as international journal Pharma and Bio science, ISSN 0975-6299.

Musculoskeletal disorders (MSDs) are medical condition mostly caused by work related occupations and working environment, affecting patients’ muscles, joints, tendons, ligaments and nerves and developing over time. According to a community sample of 73 females and 32 males aged 85 and over underwent a standardised examination at home, musculoskeletal pain was reported by 57% of those interviewed(*).

Types of Musculo-Skeletal disorders in elder

1. Osteoarthritis
2. Gout
3. Rheumatoid Arthritis
4. Polymalagia Arthritis
5. Cervical myleopathy and spinal canal stenosis
6. Osteoporosis
7. Low back pain
8. Fibromyalgia

                                          Gout

Gout mostly effected one joint is an acute and recurrent condition of arthritis as a result of uric acid building up in blood, inducing joint inflammation.




              

                                              Treatments
B. Other research and studied formulas
Kyle J. Norton (Scholar and Master of Nutrients, all right reserved)Health article writer and researcher; Over 10.000 articles and research papers have been written and published on line, including world wide health, ezine articles, article base, healthblogs, selfgrowth, best before it's news, the karate GB daily, etc.,.
Named TOP 50 MEDICAL ESSAYS FOR ARTISTS & AUTHORS TO READ by Disilgold.com Named 50 of the best health Tweeters Canada - Huffington Post
Nominated for shorty award over last 4 years
Some articles have been used as references in medical research, such as international journal Pharma and Bio science, ISSN 0975-6299.

Musculoskeletal disorders (MSDs) are medical condition mostly caused by work related occupations and working environment, affecting patients’ muscles, joints, tendons, ligaments and nerves and developing over time. According to a community sample of 73 females and 32 males aged 85 and over underwent a standardised examination at home, musculoskeletal pain was reported by 57% of those interviewed(*).

Types of Musculo-Skeletal disorders in elder

1. Osteoarthritis
2. Gout
3. Rheumatoid Arthritis
4. Polymalagia Arthritis
5. Cervical myleopathy and spinal canal stenosis
6. Osteoporosis
7. Low back pain
8. Fibromyalgia

                                          Gout

Gout mostly effected one joint is an acute and recurrent condition of arthritis as a result of uric acid building up in blood, inducing joint inflammation.


              

                                              Treatments
B. Other research and studied formulas
4. Ermiao wan
The herbal formula is widely used as anti-gouty syndrome of damp and heat in traditional Chinese medicine. According to the Nanjing University of Traditional Chinese Medicine, the effects of the herbal medicine may be due to the ingredients of alkaloids, flavonoids, organic acids which has shown to associate with reduced risk of gout arthritis(292)(293)(294).
Dr. Kong LD and colleagues at the Nanjing University, said, "atractylodis rhizomes assisted and enhanced the effect of phellodendri cortex on reduction of serum uric acid level in hyperuricemic mice, and hypouricemic effects of Ermiao wan and phellodendri cortex may be achieved by other mechanism partly instead of the XDH and XO inhibition."(295).



(292) [Fingerprint comparison of effective parts of Ermiao wan categorized formula in anti-gouty syndrome of damp and heat].[Article in Chinese] by Li X1, Yin L, Duan JA, Ding AW.(PubMed)
(293) In vitro Xanthine Oxidase Inhibitory Studies of Lippia nodiflora and Isolated Flavonoids and Phenylethanoid Glycosides as Potential Uric Acid-lowering Agents by Cheng LC, Murugaiyah V, Chan KL.(PubMed)
(294) Flavonoids and phenylethanoid glycosides from Lippia nodiflora as promising antihyperuricemic agents and elucidation of their mechanism of action by Cheng LC1, Murugaiyah V2, Chan KL3.(PubMed)
(295) A Chinese herbal medicine Ermiao wan reduces serum uric acid level and inhibits liver xanthine dehydrogenase and xanthine oxidase in mice by Kong LD1, Yang C, Ge F, Wang HD, Guo YS.(PubMed)




Most Common Disease of50plus: The Clinical trials and Studies of Musculo-Skeletal disorders(MSDs)- Gout - Treatment In TCM formula Modified Simiao Decoction

Kyle J. Norton (Scholar and Master of Nutrients, all right reserved)Health article writer and researcher; Over 10.000 articles and research papers have been written and published on line, including world wide health, ezine articles, article base, healthblogs, selfgrowth, best before it's news, the karate GB daily, etc.,.
Named TOP 50 MEDICAL ESSAYS FOR ARTISTS & AUTHORS TO READ by Disilgold.com Named 50 of the best health Tweeters Canada - Huffington Post
Nominated for shorty award over last 4 years
Some articles have been used as references in medical research, such as international journal Pharma and Bio science, ISSN 0975-6299.

Musculoskeletal disorders (MSDs) are medical condition mostly caused by work related occupations and working environment, affecting patients’ muscles, joints, tendons, ligaments and nerves and developing over time. According to a community sample of 73 females and 32 males aged 85 and over underwent a standardised examination at home, musculoskeletal pain was reported by 57% of those interviewed(*).

Types of Musculo-Skeletal disorders in elder

1. Osteoarthritis
2. Gout
3. Rheumatoid Arthritis
4. Polymalagia Arthritis
5. Cervical myleopathy and spinal canal stenosis
6. Osteoporosis
7. Low back pain
8. Fibromyalgia

                                          Gout

Gout mostly effected one joint is an acute and recurrent condition of arthritis as a result of uric acid building up in blood, inducing joint inflammation.


              


                                              Treatments
B. Other research and studied formulas
Kyle J. Norton (Scholar and Master of Nutrients, all right reserved)Health article writer and researcher; Over 10.000 articles and research papers have been written and published on line, including world wide health, ezine articles, article base, healthblogs, selfgrowth, best before it's news, the karate GB daily, etc.,.
Named TOP 50 MEDICAL ESSAYS FOR ARTISTS & AUTHORS TO READ by Disilgold.com Named 50 of the best health Tweeters Canada - Huffington Post
Nominated for shorty award over last 4 years
Some articles have been used as references in medical research, such as international journal Pharma and Bio science, ISSN 0975-6299.

Musculoskeletal disorders (MSDs) are medical condition mostly caused by work related occupations and working environment, affecting patients’ muscles, joints, tendons, ligaments and nerves and developing over time. According to a community sample of 73 females and 32 males aged 85 and over underwent a standardised examination at home, musculoskeletal pain was reported by 57% of those interviewed(*).

Types of Musculo-Skeletal disorders in elder

1. Osteoarthritis
2. Gout
3. Rheumatoid Arthritis
4. Polymalagia Arthritis
5. Cervical myleopathy and spinal canal stenosis
6. Osteoporosis
7. Low back pain
8. Fibromyalgia

                                          Gout

Gout mostly effected one joint is an acute and recurrent condition of arthritis as a result of uric acid building up in blood, inducing joint inflammation.


              


                                              Treatments
B. Other research and studied formulas
3. Modified Simiao Decoction
Modified Simiao Decoction(MSD), containing 4 herbs is also one of common used formula in traditional Cjinese medicine for treatment of gouty arthritis. According to the Huazhong University of Science and Technology, the formula attenuated successfully the accumulation of monosodium urate (MSU) crystals in the joints(289), through expression of crystals-induced inflammation through its target of reduced over reaction of proinflammatory cytokines, such as of IL-1 β and TNF α secretion(288).
Dr. Hua J and colleagues at the The Second People Hospital of Xihu District said, "MSD processes uricosuric and nephroprotective actions by regulating renal urate transporters and enhancing antioxidant enzymes activities to improve renal dysfunction in hyperuricemic mice"(290).

In fact, in the review of  a total of 120 cases of gouty arthritis randomly divided into the treatment group and control group with 60 cases in each group study, researchers indicated the effectiveness of the decoction in treatment of gout as the formula significantly improved the symptoms and signs of gouty arthritis and decrease the levels of UA and CRP(291).

(288) Effects of Modified Simiao Decoction on IL-1 β and TNF α Secretion in Monocytic THP-1 Cells with Monosodium Urate Crystals-Induced Inflammation by Liu YF1, Tu SH1, Chen Z1, Wang Y1, Hu YH1, Dong H1.(PubMed)
(289) Monosodium urate crystals trigger Nrf2- and heme oxygenase-1-dependent inflammation in THP-1 cells by Jhang JJ1, Cheng YT1, Ho CY1, Yen GC2.(PubMed)
(290) Anti-hyperuricemic and nephroprotective effects of Modified Simiao Decoction in hyperuricemic mice by Hua J1, Huang P, Zhu CM, Yuan X, Yu CH.(PubMed)
(291) Treatment of 60 cases of gouty arthritis with modified Simiao Tang by Qiu R1, Shen R, Lin D, Chen Y, Ye H.(PubMed)









Friday, 20 May 2016

Most Common Disease of50plus: The Clinical trials and Studies of Musculo-Skeletal disorders(MSDs)- Gout - Treatment In TCM formula Shuang-Qi gout capsule

Kyle J. Norton (Scholar and Master of Nutrients, all right reserved)Health article writer and researcher; Over 10.000 articles and research papers have been written and published on line, including world wide health, ezine articles, article base, healthblogs, selfgrowth, best before it's news, the karate GB daily, etc.,.
Named TOP 50 MEDICAL ESSAYS FOR ARTISTS & AUTHORS TO READ by Disilgold.com Named 50 of the best health Tweeters Canada - Huffington Post
Nominated for shorty award over last 4 years
Some articles have been used as references in medical research, such as international journal Pharma and Bio science, ISSN 0975-6299.

Musculoskeletal disorders (MSDs) are medical condition mostly caused by work related occupations and working environment, affecting patients’ muscles, joints, tendons, ligaments and nerves and developing over time. According to a community sample of 73 females and 32 males aged 85 and over underwent a standardised examination at home, musculoskeletal pain was reported by 57% of those interviewed(*).

Types of Musculo-Skeletal disorders in elder

1. Osteoarthritis
2. Gout
3. Rheumatoid Arthritis
4. Polymalagia Arthritis
5. Cervical myleopathy and spinal canal stenosis
6. Osteoporosis
7. Low back pain
8. Fibromyalgia

                                          Gout

Gout mostly effected one joint is an acute and recurrent condition of arthritis as a result of uric acid building up in blood, inducing joint inflammation.


              


                                              Treatments
B. Other research and studied formulas
2. Shuang-Qi gout capsule
Shuang-Qi gout capsule is another formula used widely in traditional Chinese medicine for treatment of of joint pain, inflammation and gout arthritis. According to the China Pharmaceutical University, application of the formula effectively inhibit the inflammation, analgesia, through the modulation of emission of pro-inflammatory cytokines and the curative effect is dose dependent manner(286).
Dr. Kodithuwakku ND and colleagues at the joint study led by the China Pharmaceutical University said, "SQ could effectively regulate the main renal transporters denoted its denote probable antihyperuricemic mechanism of SQ and its dose dependent uricosuric effect. In addition, SQ attenuated the deleterious effects of hyperuricemia with renal dysfunction"(287).

(286) Anti-inflammatory and antinociceptive effects of Chinese medicine SQ gout capsules and its modulation of pro-inflammatory cytokines focusing on gout arthritis by Kodithuwakku ND1, Pan M, Zhu YL, Zhang YY, Feng YD, Fang WR, Li YM.(PubMed)
(287) The molecular insight into the antihyperuricemic and renoprotective effect of Shuang Qi gout capsule in mice by Kodithuwakku ND1, Feng YD2, Zhang YY1, Pan M3, Fang WR4, Li YM5.(PubMed)


Most Common Disease of50plus: The Clinical trials and Studies of Musculo-Skeletal disorders(MSDs)- Gout - Treatment In TCM formula Modified Simiaowan (MSW)

Kyle J. Norton (Scholar and Master of Nutrients, all right reserved)Health article writer and researcher; Over 10.000 articles and research papers have been written and published on line, including world wide health, ezine articles, article base, healthblogs, selfgrowth, best before it's news, the karate GB daily, etc.,.
Named TOP 50 MEDICAL ESSAYS FOR ARTISTS & AUTHORS TO READ by Disilgold.com Named 50 of the best health Tweeters Canada - Huffington Post
Nominated for shorty award over last 4 years
Some articles have been used as references in medical research, such as international journal Pharma and Bio science, ISSN 0975-6299.

Musculoskeletal disorders (MSDs) are medical condition mostly caused by work related occupations and working environment, affecting patients’ muscles, joints, tendons, ligaments and nerves and developing over time. According to a community sample of 73 females and 32 males aged 85 and over underwent a standardised examination at home, musculoskeletal pain was reported by 57% of those interviewed(*).

Types of Musculo-Skeletal disorders in elder

1. Osteoarthritis
2. Gout
3. Rheumatoid Arthritis
4. Polymalagia Arthritis
5. Cervical myleopathy and spinal canal stenosis
6. Osteoporosis
7. Low back pain
8. Fibromyalgia

                                          Gout

Gout mostly effected one joint is an acute and recurrent condition of arthritis as a result of uric acid building up in blood, inducing joint inflammation.


              


                                              Treatments

B. Other research and studied formulas
1. Modified Simiaowan (MSW)
Modified Simiaowan (MSW), a TCM formula is widely used as a clinically medication formula for its efficiency in treating gouty diseases. According to the joint study led by the Nanjing University of Chinese Medicine, the formula targeted related pathways involving gouty diseases through inhibited pro inflammatory cytokines and uric acid synthetase or transporters, via heat-clearing and dampness-eliminating herbs in MSW physicochemical properties(284).
Dr. Shi L and colleagues said, "MSW could significantly prevent the paw swelling and neutrophil infiltration induced by intra-articular MSU injection in rats. MSW also showed potent analgesic effects at (5.0, 10, and 20 g/kg body weight) in acetic acid-induced mice depending on the dosage" in 
gouty arthritis mice(285).

(284) Shu Feng Huo Xue Tang by (Root down US)
(284) A network pharmacology approach to determine active ingredients and rationality of herb combinations of Modified-Simiaowan for treatment of gout.by Zhao F1, Guochun L2, Yang Y3, Shi L1, Xu L1, Yin L4.(PubMed)
(285) Suppressive effect of modified Simiaowan on experimental gouty arthritis: an in vivo and in vitro study by Shi L1, Xu L, Yang Y, Song H, Pan H, Yin L(PubMed)




Thursday, 19 May 2016

Most Common Disease of50plus: The Clinical trials and Studies of Musculo-Skeletal disorders(MSDs)- Gout - Treatment of Gout due to Wind-Damp, Phlegm and Blood stasis in TCM

Kyle J. Norton (Scholar and Master of Nutrients, all right reserved)Health article writer and researcher; Over 10.000 articles and research papers have been written and published on line, including world wide health, ezine articles, article base, healthblogs, selfgrowth, best before it's news, the karate GB daily, etc.,.
Named TOP 50 MEDICAL ESSAYS FOR ARTISTS & AUTHORS TO READ by Disilgold.com Named 50 of the best health Tweeters Canada - Huffington Post
Nominated for shorty award over last 4 years
Some articles have been used as references in medical research, such as international journal Pharma and Bio science, ISSN 0975-6299.

Musculoskeletal disorders (MSDs) are medical condition mostly caused by work related occupations and working environment, affecting patients’ muscles, joints, tendons, ligaments and nerves and developing over time. According to a community sample of 73 females and 32 males aged 85 and over underwent a standardised examination at home, musculoskeletal pain was reported by 57% of those interviewed(*).

Types of Musculo-Skeletal disorders in elder

1. Osteoarthritis
2. Gout
3. Rheumatoid Arthritis
4. Polymalagia Arthritis
5. Cervical myleopathy and spinal canal stenosis
6. Osteoporosis
7. Low back pain
8. Fibromyalgia

                                          Gout

Gout mostly effected one joint is an acute and recurrent condition of arthritis as a result of uric acid building up in blood, inducing joint inflammation.
           


                                              Treatments

In Traditional Chinese medicine perspective
A. Treatment according to TCM assistant in the article of "Chinese herbal formula(s) can treat or relief Gout"(27), in Chinese medicine, gout is a condition of a joint painful wind syndrome caused by
3. Wind-Damp, Phlegm and Blood stasis
3.1. Wind-Damp, Phlegm and Blood stasis lead to acute attack of gout. arthritis, difficulty in movement, joint pain, edema of lower extremities, swelling of joints;, chills, etc.
3.2. Chinese herbal formula Shu Feng Huo Xue Tang used to disperses Damp and Wind, eliminates Blood stasis
a. Gui Zhi (Cinnamon twig, cassia twig) 2.5g
b. Qiang Huo (Notopterygium root, chiang-huo) 2.5g
c. Bai Zhi (Angelica root) 2.5g
d. Huang Bai (amur cork tree bark, phellodendron bark) 2.5g
e. Wei Ling Xian (Chinese clematis root, clematis) 2.5g
f. Cang Zhu (Atractylodes rhizome) 2.5g
g. Chuan Xiong (Sichuan lovage root, cnidium, Chuanxiong root) 2.5g
h. Hong Hua (Safflower flower, Carthamus) 1g
i. Gan Jiang (Dried ginger rhizome) 1g
j. Dang Gui (Chinese angelica root) 2.5g
k. Dan Nan Xing (P Arisaematis cum Fel Bovis) 2.5g
l. Han Fang Ji (Stephania root) 2.5g(283)


Most Common Disease of50plus: The Clinical trials and Studies of Musculo-Skeletal disorders(MSDs)- Gout - Treatment of Gout due to Recurrent Wind-Cold-Damp in TCM

Kyle J. Norton (Scholar and Master of Nutrients, all right reserved)Health article writer and researcher; Over 10.000 articles and research papers have been written and published on line, including world wide health, ezine articles, article base, healthblogs, selfgrowth, best before it's news, the karate GB daily, etc.,.
Named TOP 50 MEDICAL ESSAYS FOR ARTISTS & AUTHORS TO READ by Disilgold.com Named 50 of the best health Tweeters Canada - Huffington Post
Nominated for shorty award over last 4 years
Some articles have been used as references in medical research, such as international journal Pharma and Bio science, ISSN 0975-6299.

Musculoskeletal disorders (MSDs) are medical condition mostly caused by work related occupations and working environment, affecting patients’ muscles, joints, tendons, ligaments and nerves and developing over time. According to a community sample of 73 females and 32 males aged 85 and over underwent a standardised examination at home, musculoskeletal pain was reported by 57% of those interviewed(*).

Types of Musculo-Skeletal disorders in elder

1. Osteoarthritis
2. Gout
3. Rheumatoid Arthritis
4. Polymalagia Arthritis
5. Cervical myleopathy and spinal canal stenosis
6. Osteoporosis
7. Low back pain
8. Fibromyalgia

                                          Gout

Gout mostly effected one joint is an acute and recurrent condition of arthritis as a result of uric acid building up in blood, inducing joint inflammation.


              


                                              Treatments



In Traditional Chinese medicine perspective
A. Treatment according to TCM assistant in the article of "Chinese herbal formula(s) can treat or relief Gout"(27), in Chinese medicine, gout is a condition of a joint painful wind syndrome caused by
2. Recurrent Wind-Cold-Damp
2.1. Recurrent Wind-Cold-Damp painful obstruction in which localized constraint generates Heat of that can lead to acute attack of gout, arthritis, difficulty in movement, joint pain, edema of lower extremities, painful lower limbs, rheumatism;, swelling of joints, etc.
2.2. Chinese herbal formula Gui Zhi Shao Yao Zhi Mu Tang used to disperses Damp and Wind, unblocks the Channels. moves Yang, etc.
a. Gui Zhi (Ramulus Cinnamomi Cassiae, Cinnamon, Cassia Twig) – 12g. -warms and unblocks channels
b. Ma Huang (Herba Ephedrae, Ephedra Stem, ma-huang) – 6g. -unblocks channels, relieves superficial swellings
c. Fu Zi (Radix lateralis Aconiti Carmichaeli, Szechuan Aconite Root, Aconite) – 6g. -warms channels, relieves pain
d. Zhi Mu (Rhizoma Anemarrhenae Asphodeloidis, Anemarrhena Rhizome) – 12g. -clear heat from the joints, nourish yin
e. Shaoyao (Radix Paeoniae , Peony Root) – 9g. -clear heat, nourish yin
f. Bai Zhu (Rhizoma Atractyloids Macrocephaelae, Atractylodes White Rhizome) – 15g. -harmonizes ying and wei Qi levels (Bai Shao)
g. Fang Feng (Radix ledebouriellae, Ledebouriella Root, Siler) – 12g. -expels wind and dampness
h. Sheng Jiang (Rhizoma Zingiberis officinalis Recens, Fresh Ginger Rhizome) – 15g. -promotes Qi circulation
i. Gan Cao (Radix Glycyrrhizae uralensis, Licorice Root) – 6g. -harmonizes other herbs within formula, regulates middle jiao(282).








Wednesday, 18 May 2016

Most Common Disease of50plus: The Clinical trials and Studies of Musculo-Skeletal disorders(MSDs)- Gout - Treatment of Gout due to Damp-Heat in TCM

Kyle J. Norton (Scholar and Master of Nutrients, all right reserved)Health article writer and researcher; Over 10.000 articles and research papers have been written and published on line, including world wide health, ezine articles, article base, healthblogs, selfgrowth, best before it's news, the karate GB daily, etc.,.
Named TOP 50 MEDICAL ESSAYS FOR ARTISTS & AUTHORS TO READ by Disilgold.com Named 50 of the best health Tweeters Canada - Huffington Post
Nominated for shorty award over last 4 years
Some articles have been used as references in medical research, such as international journal Pharma and Bio science, ISSN 0975-6299.

Musculoskeletal disorders (MSDs) are medical condition mostly caused by work related occupations and working environment, affecting patients’ muscles, joints, tendons, ligaments and nerves and developing over time. According to a community sample of 73 females and 32 males aged 85 and over underwent a standardised examination at home, musculoskeletal pain was reported by 57% of those interviewed(*).

Types of Musculo-Skeletal disorders in elder

1. Osteoarthritis
2. Gout
3. Rheumatoid Arthritis
4. Polymalagia Arthritis
5. Cervical myleopathy and spinal canal stenosis
6. Osteoporosis
7. Low back pain
8. Fibromyalgia

                                          Gout

Gout mostly effected one joint is an acute and recurrent condition of arthritis as a result of uric acid building up in blood, inducing joint inflammation.


              


                                              Treatments



In Traditional Chinese medicine perspective
A. Treatment according to TCM assistant in the article of "Chinese herbal formula(s) can treat or relief Gout"(27), in Chinese medicine, gout is a condition of a joint painful wind syndrome caused by
1.  Formula for Damp-Heat induced gout
1.1. Painful obstruction due to the containment of Damp-Heat in the channels of that can lead to acute articular rheumatism, acute attack of gout, arthritis, hot joints, joint pain, tremors, dark urine, etc.
1.2. Chinese Herbal Formula Xuan Bi Tang used to clear and damp-Heat, unblock the Channels, eliminate painful obstruction, etc. Ingredients include
a. Guang Fang Ji (Radix Aristolochiae Fangchi, Aristolochia Root, Stephania) – 15g. -expels damp heat in upper jiao, expels superficial swellings, induces urination
b. Xing Ren (Semen Pruni Armeniacae, Apricot Seed) – 15g. -regulates lung Qi and water metabolism
c. Yi Yi Ren (Semen Coicis Lachryma Jobi) – 15g. -tonify spleen, clear dampness, relieve painful obstructions
d. Can Sha (Excrementum Bombycis Mori, Silkworm Feces) – 9g. -tonify spleen, clear dampness, relieve painful obstructions
e. Ban Xia (Rhizoma Pinelliae Tematae, Pinellia Rhizome) – 9g. -dries dampness, transforms tubidity
f. Lian Qiao (Fructus Forsythiae Suspensae, Forsythia Fruit) – 9g. -clears superficial heat
g. Zhi Zi (Fructus Gardeniae Jasminoidis, Cape Jasmine Fruit, Gardenia) – 9g. -clear heat, drains dampness, induces urination
h. Hua Shi (Talcum, Talcum) – 15g. -clear heat, drains dampness, induces urination
i. Chi Xiao Dou (Semen Phaseoli Calcarati) – 9g. -clears heat, drains dampness, induces urination(281)